There is growing interest in the concepts of listening effort and fatigue associated with hearing loss. However, the theoretical underpinnings and clinical meaning of these concepts are unclear. This lack of clarity reflects both the relative immaturity of the field and the fact that research studies investigating listening effort and fatigue have used a variety of methodologies including self-report, behavioural, and physiological measures. This discussion paper provides working definitions for listening effort and listening-related fatigue. Using these definitions as a framework, methodologies to assess these constructs are reviewed. Although each technique attempts to characterize the same construct (i.e. the clinical presentation of listening effort and fatigue), different assumptions are often made about the nature of these phenomena and their behavioural and physiological manifestations. We suggest that researchers consider these assumptions when interpreting their data and, where possible, make predictions based on current theoretical knowledge to add to our understanding of the underlying mechanisms of listening effort and listening-related fatigue. Following recent interest in the cognitive involvement in hearing, the British Society of Audiology (BSA) established a Special Interest Group on Cognition in Hearing in May 2013. In an exploratory group meeting, the ambiguity surrounding listening effort and fatigue was discussed. To address this problem, the group decided to develop a 'white paper' on listening effort and fatigue. This is a discussion document followed by an international set of commentaries from leading researchers in the field. An approach was made to the editor of the International Journal of Audiology who agreed to this suggestion. This paper, and the associated commentaries that follow, are the result.

Eighty-seven primary-school children with impaired hearing were evaluated using speech perception, production, and language measures over a 3-year period. Forty-seven children with a mean unaided pure-tone-average hearing loss of 106 dB HL used a 22-electrode cochlear implant, and 40 with a mean unaided puretone-average hearing loss of 78 dB HL were fitted with hearing aids. All children were enrolled in oral/aural habilitation programs, and most attended integrated classes with normally hearing children for part of the time at school. Multiple linear regression was used to describe the relationships among the speech perception, production, and language measures, and the trends over time. Little difference in the level of performance and trends was found for the two groups of children, so the perceptual effect of the implant is equivalent, on average, to an improvement of about 28 dB in hearing thresholds. Scores on the Peabody Picture Vocabulary Test (PPVT) and the Clinical Evaluation of Language Fundamentals showed an upward trend at about 60% of the rate for normally hearing children. Rates of improvement for individual children were not correlated significantly with degree of hearing loss. The children showed a wide scatter about the average speech production score of 40% of words correctly produced in spontaneous conversations, with no significant upward trend with age. Scores on the open-set Consonant-Nucleus-Consonant (CNC) monosyllabic word test and the Bench-Kowal-Bamford (BKB) sentence test were strongly related to language level (as measured by an equivalent age on the PPVT) and speech production scores for both auditory-visual and auditory test conditions. After allowing for differences in language, speech perception scores in the auditory test condition showed a slight downward trend over time, which is consistent with the known biological effects of hearing loss on the auditory periphery and brainstem. Speech perception scores in the auditory condition also decreased significantly by about 5% for every 10 dB of hearing loss in the hearing aid group. The regression analysis model allows separation of the effects of language, speech production, and hearing levels on speech perception scores so that the effects of habilitation and training in these areas can be observed and/or predicted. The model suggests that most of the children in the study will reach a level of over 90% sentence recognition in the auditory-visual condition when their language becomes equivalent to that of a normally hearing 7-year-old, but they will enter secondary school at age 12 with an average language delay of about 4 or 5 years unless they receive concentrated and effective language training.

Objective: This study explored the psychosocial experiences of adults with hearing loss using the self-regulatory model as a theoretical framework. The primary components of the model, namely cognitive representations, emotional representations, and coping responses, were examined. Design: Individual semi-structured interviews were conducted. The data were analysed using an established thematic analysis procedure. Study sample: Twenty-five adults with mild-moderate hearing loss from the UK and nine hearing healthcare professionals from the UK, USA, and Canada were recruited via maximum variation sampling. Results: Cognitive representations: Most participants described their hearing loss as having negative connotations and consequences, although they were not particularly concerned about the progression or controllability/curability of the condition. Opinions differed regarding the benefits of understanding the causes of one’s hearing loss in detail. Emotional representations: negative emotions dominated, although some experienced positive emotions or muted emotions. Coping responses: engaged coping (e.g. hearing aids, communication tactics) and disengaged coping (e.g. withdrawal from situations, withdrawal within situations): both had perceived advantages and disadvantages. Conclusions: This novel application of the self-regulatory model demonstrates that it can be used to capture the key psychosocial experiences (i.e. perceptions, emotions, and coping responses) of adults with mild-moderate hearing loss within a single, unifying framework.

Behavioural and electrophysiological studies give differing impressions of when auditory discrimination is mature. Ability to discriminate frequency and speech contrasts reaches adult levels only around 12 years of age, yet an electrophysiological index of auditory discrimination, the mismatch negativity (MMN), is reported to be as large in children as in adults. Auditory ERPs were measured in 30 children (7 to 12 years), 23 teenagers (13 to 16 years) and 32 adults (35 to 56 years) in an oddball paradigm with tone or syllable stimuli. For each stimulus type, a standard stimulus (1000 Hz tone or syllable [ba]) occurred on 70% of trials, and one of two deviants (1030 or 1200 Hz tone, or syllables [da] or [bi]) equiprobably on the remaining trials. For the traditional MMN interval of 100–250 ms post‐onset, size of mismatch responses increased with age, whereas the opposite trend was seen for an interval from 300 to 550 ms post‐onset, corresponding to the late discriminative negativity (LDN). Time‐frequency analysis of single trials revealed that the MMN resulted from phase‐synchronization of oscillations in the theta (4–7 Hz) range, with greater synchronization in adults than children. Furthermore, the amount of synchronization was significantly correlated with frequency discrimination threshold. These results show that neurophysiological processes underlying auditory discrimination continue to develop through childhood and adolescence. Previous reports of adult‐like MMN amplitudes in children may be artefactual results of using peak measurements when comparing groups that differ in variance.